Understanding State Reconfiguration: An Elite Approach

Ironically, to try to understand the process of state reconfiguration, researchers have pointed to the “strength” of politics in weak states, such as the United States [Novak Reference Novak2008; King and Liebermann Reference King and Lieberman2009a, Reference King, Lieberman, Desmond and Jacobs2009b; King and Jacobs Reference King and Jacobs2009]. Based on states’ ability to formulate and implement policies, these scholars have relativized the distinction between strong and weak states. Thus, in the case of the United States, the concept of a weak state has been abandoned in favor of the “policy state” [Orren and Skowroneck Reference Orren and Skowronek2017]. The latter developed during brief historical sequences (the Progressive Era, civil rights, and so on) in which interventionist policies highlighted the strength of the federal state. Far from being linear, its development varied according to the policy areas favored by the party in power [Jacobs, King, and Milkis Reference Jacobs, King and Milkis2019; Skowronek, Dearborn, and King Reference Skowronek, Dearborn and King2021]. Using the same approach, the study of the reconfiguration of European states, in which each state is forced to elaborate and adapt its actions to those of the European Union (EU), maintains that they have structurally weakened [King and Le Galès Reference King and Le Galès2017a].

However, comparative historical sociology has pointed to the importance of elites carrying out political and institutional change [Linz Reference Linz, Rokkan and Eisenstadt1973 and Reference Linz1993]. Our research has allowed us to understand how, over the past three decades, in certain strategic sectors (welfare and warfare), small groups of unelected governmental elites have promoted state interventionism against neoliberal ideology or at least to control its negative effects on welfare policies [Genieys Reference Genieys2010; Genieys and Joana Reference Genieys and Joana2017]. Our elite approach rests on two postulates: (i) a plurality of unelected governmental elite groups competing to formulate programmatic orientationsFootnote ³; (ii) the effects on these programmatic visions of changes in the elite structure [Genieys and Darviche Reference Genieys and Darviche2023; Genieys Reference Genieys2024]. To this end, we focused on governmental elites who are (i) unelected individuals, (ii) politically appointed at the apex of the state apparatus, and (iii) able to develop their career path over the long term by circulating vertically (occupational advancement) and horizontally (between governmental institutions) inside the state,Footnote ⁴ while (iv) working collectively out of sight and (v) decisively influencing policymaking.

In developing the Programmatic Elites Framework, we have combined an “applied sociography”Footnote ⁵ with the transformation of programmatic orientations. The “applied sociography” is based on a population of unelected governmental elites identified on the basis of positions held over time (temporal criterion) in the governance of social security (positional criterion). First, we studied their social background features (age, gender, type and level of diploma, profession, and so on).Footnote ⁶ Second, we deepened the sociographic analysis by linking their individual career paths with the political struggles waged for social security reform. The aim is to show how, in these struggles, groups of unelected governmental elites have developed the role of “custodians of state policies.”

Philip Selznick defined “custodians of policy” as individuals protecting certain “social values” in order to assert leadership, group identity, and autonomy within an organization [Selznick Reference Selznick1957: 120–121]. In our conception, the role of “custodian” refers to elites fighting for what they consider to be a “responsible” extension of the state [Genieys and Darviche Reference Genieys and Darviche2023]. This role is shaped by both the ethics of ultimate ends and the ethics of responsibility [Weber 2004]: (a) the development of policies strengthening the regulatory capacity of the public authority (ethics of ultimate ends); and (b) the will to formulate effective “sustainable” policies taking into consideration political and budgetary constraints, among others (ethics of responsibility). This ethic of responsibility is the result of a long career path inside the state apparatus and a specialization in a particular policy domain. In the welfare regime, the identification of this role has made it possible to differentiate a group of elites defending the public interest from those promoting a certain view of the market (liberalism) and from those representing social forces (corporatism).

In the French and American case studies, despite the contrasting development of their respective states, we observed the role of unelected governmental elites in welfare reforms [Genieys and Darviche Reference Genieys and Darviche2023; Genieys Reference Genieys2024]. In the context of the US policy state, it was short-lived and contested because of constitutional rules and the balance of power. The interventionist policies initiated by the Progressivist elites during the Roosevelt administration and later under the Johnson administration with the Great Society program were severely attenuated by the return to government of the Republicans [Pierson Reference Pierson1994; Orren and Skowronek Reference Orren and Skowronek2017]. More recently, however, a study of the origins of the Affordable Care Act has identified a new manifestation of the custodian role. Indeed, a group of democratic elites —“long-term insiders”— was able to promote pragmatic state interventionism that took into account budgetary constraints and those imposed by the Republican opposition in order to bring about this reform. This “government of insiders” neutralized market forces, as well as the forces opposing more statist reform (“single payer,” “public option”) deemed impossible to implement in the context of strong political polarization.

Concerning France, our research has identified the same type of process in a strong-state context over the long term. Studying the transformation of social security governance in France between 1970 and 2020 allowed us to analyze how unelected governmental elites transformed themselves while reconfiguring government authority in this sector [Genieys Reference Genieys2010; Genieys and Darviche Reference Genieys and Darviche2023]. A group of high-level civil servants, whom we have called “welfare elites,” and characterized by a new professional background (from the Cour des comptes) and a career path specializing in cost control issues (Directorate of Social Security), promoted the 1996 constitutional reform (Tables 2 and 5). At the apex of social security governance these new elites pursued a programmatic orientation that we will call “sustainable social welfare,”Footnote ⁷ whose goal was to strengthen the role of the state by taking control of social security and its financing, while universalizing and extending it. In order to continue to assert their political autonomy with regard to this program after reform, they assumed the role of custodians of state policies in the process of transforming the welfare regime.

Evidence from the Transformation of the French Welfare Regime

The transformation of the French welfare regime is a rewarding policy area of study for anyone interested in the connection between elite changes and state reconfiguration. In the case of France, from the 1970s and then the 1990s, in order to meet the challenge of the oil crises and mass unemployment, social security governance underwent a first wave of structural reforms [Hassenteufel and Palier Reference Hassenteufel and Palier2007; Palier Reference Palier2000, Reference Palier2004 and Reference Palier2010]. Comparative research emphasizes that direct tax revenue replaced a portion of the financing from salary withholding and employer contributions in France [Merrien, Parchet and Kernen Reference Merrien, Parchet and Kernen2005: 353]. The share of social contributions in social security revenues decreased from 82% in 1981 to 56% in 2020.Footnote ⁸ This trend is particularly marked for health insurance (including occupational injuries), which is the most expensive, accounting for 57% of expenditure (32% for pensions and 11% for family policy expenditure).Footnote ⁹ Today, almost two-thirds of its revenues come from taxation.Footnote ¹⁰

The continuous increase in state financing, particularly in the costly health sector, in which taxes now exceed social security contributions, has favored the emergence of new unelected governmental elites specializing in expenditure control. Our replicated studies over timeFootnote ¹¹ have highlighted the sociological features of the different types of unelected governmental elites that have succeeded one another at the apex of social security administration [Genieys Reference Genieys2010; Genieys Reference Genieys2024; Darviche, Genieys, and Hassenteufel Reference Darviche, Genieys and Hassenteufel2022]. The programmatic elite framework makes it possible to define the ideal-type of elites by combining the characteristics of the elite structure (social background and career path) with the type of programmatic orientation (formulation and implementation of a policy program). Based on our empirical data, we differentiated three types of unelected governmental elites: the “old-fashioned” social security elites attached to the Bismarckian model, the welfare elites promoting “sustainable social welfare,” and the elites of the Ministry of Finance who are more inclined to defend strict budget constraints (see Table 2). A more in-depth sociographic analysis of welfare elites has enabled us to divide them into two generations (Table 4). Indeed, social backgrounds and career paths have changed between the two generations, confirming the institutionalization of the second generation at the heart of the state. While the first generation led the program up to and beyond the constitutional reform of 1996, the second generation formed by the first took over implementation and defense (Table 5).

Table 1

The Three research programs on welfare elites from 1997 to 2020

Table 2

Elites types and social security governance (1945 to 2020)

Sources: Authors’.

Table 3

Characteristics of the French Grands corps involved in social insurance governance

Sources: Authors’.

Table 4

Social background and career path of the old and new elites (1945-2020)

Sources: Authors’.

Table 5

Generations of welfare elites, reforms and programmatic issues

Sources: Authors’.

The aim of the 1996 reform was (i) to strengthen the state’s control over health insurance expenditure. At the same time, it was (ii) associated with the political desire to establish a national health system. This constitutional reform, which substantially transformed the governance and principle of access to health care inherited from the Bismarckian model, reveals a major break in the programmatic orientation of social security and confirms the replacement of the “old-fashioned” social security elites by welfare elites (see Tables 2, 4, and 5). The development of a new programmatic orientation and the series of reforms implementing it were correlated with the arrival of new elites at the head of social security administration.

Within the state, these elites are identified by social backgrounds and career paths distinct from those of the “old-fashioned” elites (from 1945 to 1980), the conseillers d’État (see Tables 2, 3, and 4). Between 1980 and 1999, a first generation of welfare elites, composed of magistrates of the Cour des comptes, took over the Directorate of Social Security (DSS), carrying out a policy change agenda that culminated in the 1996 constitutional reform (Social Security Budget Act, LFSS). Its implementation led to the advent of a second generation of welfare elites, with career paths shaped, over the long term, inside the institutions of social security governance (Directorate of Social Security, Fund directorates, ministerial cabinets, see Table 4). In the context of the power struggle with the unions (Funds), but especially, after 2007, with the elites of the Ministry of Finance, this generation of elites took on the role of custodians of state policies. By promoting the “sustainable social welfare” program, the welfare elites initiated a process of reconfiguration of the French state in a domain of constantly expanding policies (Tables 2 and 5).

The Fall of the “Old Fashioned” Social Security Elites

After the Second World War, the Constitution of the Fourth Republic profoundly transformed the French welfare state. Inspired by Conseiller d’État Pierre Laroque, the so-called “founding father,” the legislative decrees of October 4, 1945 laid the basis of the social security system and health care coverage [Palier Reference Palier2010]. Imposed under the aegis of a broad political compromise, this system differs significantly from its British equivalent, the National Health Service (NHS), which is heavily state-funded, financed by tax revenues, not by social contributions (cotisations sociales) as in France [Esping-Andersen Reference Espin-Andersen1990]. The system was governed jointly by “old-fashioned’ social security elites: the unions (workers and employers) and high-ranking Ministry of Social Affairs civil servants from the Conseil d’État (Tables 2 and 3). Considered the logical outcome of the wage-based society, the social protection system created in 1945 was exceptional in French institutional history [Palier Reference Palier2002].

Paradoxically, in this strong-state country, the political influence of the administrative elites seems, reflecting the relations between political forces at the time of the “Libération” (after World War II), to have been less decisive than it was in the United Kingdom or Sweden during the same period [Heclo Reference Heclo1974]. Although the French state was highly interventionist in major areas of economic and social life (for example, nationalization of industrial groups and banks, planning, training of elites [ENA, and so on]), it was less so when it came to social protection [Suleiman Reference Suleiman1974 and 1978; Kuisel Reference Kuisel1973]. After two decades of “a golden age,” its original model of government was gradually called into question due to a structural increase in social spending [Tasso Reference Tasso1991: 168]. Massive unemployment caused by the successive oil shocks of 1973 and 1979 led to the creation of the first Social Security Financing Plan by Raymond Barre’s conservative government on September 22, 1976 [Palier Reference Palier2002: 176]. In the 1980s, the issue of the structural deficit was a key point of conflict between social partners and divided unelected governmental elites: (i) the “old-fashioned” elites, (ii) the welfare elites, and (iii) the Ministry of Finance elites (see Tables 2 and 3). With different social backgrounds and career paths, these unelected governmental elites were divided on the nature of the problem and the policies likely to remedy it (solutions). The “old-fashioned” social security elites defended the status quo on governance based on funds and wanted broader social benefits. The welfare elites promoted the idea of reforming the governance of social security. And the Ministry of Finance elites wanted to impose budgetary austerity and strict spending controls.

In this conflictual situation, finding new ways of regulating expenditure and social security governance was an important item on the political agenda [Barbet and Briet Reference Barbet and Briet1988; Brookes Reference Brookes2021]. Between 1980 and 1997, emerging welfare elites, in particular when they rose to lead the Directorate of Social Security and the insurance funds, promoted far-reaching reform of French welfare regime. This was concomitant with the rise to the top of a group of high civil servants characterized by a different social background (trained at the ENA, but coming from another Grand corps, the Cour des comptes) and new career paths oriented towards controlling social security expenditure (see Tables 2 and 4). The welfare elites fought their first battle on the issues of governance and control of social security expenditure against the elites who had traditionally administered social security, defending the 1945 model, including the elites of the Conseil d’État and the trade unions. Supported by a prominent figure of the first generation of welfare elites, Jean Marmot [Genieys and Darviche, Reference Genieys and Darviche2003, Chapter 3], a magistrate at the Cour des comptes who went on to become Director of Social Security, the creation of the Social Security Accounts Commission in 1979 enabled them to lay the foundations for a policy of controlling expenditure.Footnote ¹²

Two proposals were put forward simultaneously by the first generation of welfare elites: ensure the future financing of social security while adopting universal coverage [Rodwin Reference Rodwin2003; Rodwin and Le Pen Reference Rodwin and Le Pen2004; Nay et al. Reference Nay, Béjan, Bénamouzig, Bergeron, Castel and Ventelou2016]. These were the first policy solutions to emerge from their “sustainable social welfare” program, which involved operationalizing far-reaching reform of social security governance by granting more regulatory power to the state while creating the conditions for extending social insurance.

Advent of the First Generation of Welfare Elites

Our studies of elites’ changing sociological structure show the importance of “palace wars” in understanding the process of state reconfiguration. Struggles around social security governance involve members of the French state’s three grands corps Footnote ¹³ (Table 3). Between 1980 and 1996, the first struggle pitted a new group of elites composed of magistrates from the Cour des comptes (the first generation) against the “old-fashioned” elites of the Conseil d’État, heirs to Pierre Laroque, for the conquest of power at the head of the Directorate of Social Security (see Tables 2 and 4). The conflict also concerned the programmatic orientation of policies: the magistrates of the Cour de comptes, trained in controlling public accounts, promoted strong control of expenditures, while those of the Conseil d’État, trained in law and social philosophy, defended the 1945 Bismarckian model (Table 3). The second struggle pitted the magistrates of the Cour des comptes against the elites of the Ministry of Finance (from another grand corps: the Inspection générale des finances) over the issue of exercising control over the growing share of the state budget devoted to social security. This budget increase became structural with the creation of a new tax: the generalized social insurance contribution (Contribution Sociale Généralisée, CSG) (Tables 2 and 5).

Unlike social insurance contributions, the CSG is levied on all types of personal income, including wages (even the lowest ones), but also extending to capital revenues and welfare benefits [Hassenteufel and Palier Reference Hassenteufel and Palier2007: 590]. The introduction of this earmarked tax has had two main outcomes, which entail a partial shift towards a Beveridgean welfare regime [Genieys and Hassenteufel Reference Genieys, Hassenteufel, Powell, Béland and Agartan2024]. First, because funding does not come exclusively from the working population, the CSG breaks the link between employment and entitlement. Access to CSG-financed benefits cannot be limited to any social group. The shift in financing has thus created the conditions for establishing citizenship-based social rights, especially in health care. Second, it leaves the social partners with less legitimacy to participate in social security management and decision-making. This shift towards taxation constitutes a lever for transferring political control from the social partners to the state.Footnote ¹⁴

By studying the sociological features of the first generation of social elites, we can establish a link with the transformation of social security governance and policy (see Tables 2 and 4). While they were still high civil servants trained at ENA, they were also magistrates at the Cour des comptes (status) specializing in auditing public accounts (see Table 3). Equipped with specialized professional know-how hitherto non-existent in the social security field, they developed new careers based on expenditure control. In 1980, Prime Minister Raymond Barre’s appointment of Jean Marmot,Footnote ¹⁵ a magistrate from the Cour des comptes (the French Court of Auditing), to head the DSS appeared to amount to choosing a third way between Conseil d’État and Inspecteurs généraux de finances candidates. Seemingly a matter of chance or political contingency, this appointment was at the root of the advent of welfare elites, as the Cour des comptes won out against the other grands corps inside the state.

This change in elite structure strengthened the state’s ability to intervene in social security policies (see Tables 2 and 4). To exploit their expertise and influence on policy formulation, the magistrates of the Cour des comptes oriented their career paths towards the Directorate of Social Security. They were also appointed as health and social insurance policy advisors within the cabinets of the Ministry of Health and Social Affairs, the prime minister and even the Secretariat of the Presidency of the Republic. Finally, some have held the position of Director of National Sickness Insurance Funds (Caisses nationales de l’assurance maladie des travailleurs sociaux, CNAMTS) and Director of National Family Allowance Funds (Caisses nationales des affaires familiales, CNAF). However, between 1981 and 1996, the numerous political alternations and “cohabitations”Footnote ¹⁶ forced members of the first generation of welfare elites to leave social security governance. At a time of strong right–left polarization, they returned to the Social Chamber of the Cour des comptes (see Table 4). This choice strengthened their interpersonal bonds and enabled them to extend their expertise in evaluating social security accounts policy. Likewise, most of them are committed to the public interest, and have chosen to extend their careers with the state over the long term.

In attaining key positions in social security governance, the first generation of welfare elites managed to establish a political consensus on the need to adapt the social security system to the macroeconomic context in the wake of the oil crisis and mass unemployment. The original aim of the “sustainable social welfare” program was to safeguard social security. This orientation was translated into two policies: controlling costs and strengthening the state’s ability to intervene. Taking advantage of the socialist Bérégovoy government’s policy of budgetary austerity, the elites of the Ministry of Finance won out against the welfare elites in inter-ministerial arbitration on budgetary issues. To move past the Ministry of Health and Social Affairs’ image as a “big spender,” the welfare elites emphasized their ability to develop original expenditure-control instruments adapted to the challenges of health insurance policies. This enhanced capacity to shape policy was accompanied by a weakening of the social partners’ power in managing the system.

For all these reasons, in the 1990s reform of overall social security governance became a priority on the political agenda of successive presidencies. Thus, after the election of the right-wing candidate Jacques Chirac to the Presidency of the Republic in 1995, a constitutional reform project whose major institutional innovation was the establishment of annual control of the social security accounts by the legislature was promoted by the first generation of the welfare elites, then heading the Directorate of Social Security and occupying key policy advisor positions in ministerial cabinets (see Tables 2, 4, and 5). Adopted in 1996, the Social Security Budget Act (Loi de finance de la sécurité sociale, LFSS) allowed the National Assembly to establish an annual National Health Spending Objective (Objectif national de dépenses d’assurance maladie, ONDAM). Because of the balance of power in France, this reform extended the regulatory power of the administration, particularly that of the DSS, which could then strengthen its financial control over all the administrative directorates of the Ministry of Health and Social Affairs.Footnote ¹⁷ Our studies pointed out that the DSS was exclusively led by people with a specific social background and career paths characteristic of the first generation of welfare elites (see Tables 4 and 5).

The latter’s reform agenda was not limited to issues of social security governance. The “sustainable social welfare” program also proposed a transformation of access to health insurance for all citizens. The project on the political agenda was so-called Universal Health Insurance (Assurance maladie universelle, AMU). As drafted by a young member of the welfare elites, Anne-Marie Brocas, it was include in the Juppé Plan brought before the National Assembly on November 15, 1995. This innovative scheme simplified the system by linking people who were not covered to a compulsory scheme and by harmonizing social benefits between the different régimes. Universal Health Insurance (AMU) had to provide the same social benefits to everyone as long as the residency requirement was met. After the general strike of December 1995, it was removed from the reform project. Three years later, however, in 1999, during the third period of “political cohabitation” (1997–2002), Lionel Jospin’s socialist government took it up and adopted it with the passing of the law on National Health Coverage (Couverture maladie universelle, CMU). These far-reaching reforms (governance and cost control [1996] and universal health coverage [1999]) led to a profound transformation of the French welfare regime from the Bismarckian to the Beveridgean model (see Tables 2 and 5). These two programmatic dimensions, seen as consubstantial by both center-right and social-democratic welfare elites, helped to rally conservative (Juppé) and progressive (Jospin) governments to the social security reforms. A study of the institutionalization of the second generation of welfare elites confirms the process of depoliticization.

A Second Generation of Welfare Elites Shaped by the Iron Triangle

Since 1996, transformation of the social security model has led to a series of reforms. This historical sequence corresponds to the institutionalization of a second generation of welfare elites characterized by various social backgrounds and career paths (Tables 4 and 5). During this period, this generation shaped fund governance by bringing the social partners under its political authority (Douste-Blazy Law 2004). Moreover, in the context of austerity policies and the 2008 financial crisis, they had to contain the strategy of the elites of the Ministry of Finance to take over management of the social security budget, which had grown bigger than that of the state.Footnote ¹⁸ With the creation of a Ministry of Public Accounts in 2007 under the Sarkozy presidency, the Ministry of Finance elites also argued that the existence of two finance laws in France (one for the state and one for social security) put it at odds with EU budgetary rules. The European Commission considers the social security budget to be part of the state’s overall budget. In this unfavorable socio-economic context, the second génération of welfare elites acted as custodians of state policies to protect their autonomy of action. The affirmation of this role was related to the development of new career paths within the Iron Triangle Footnote ¹⁹ of social security governance (Diagram 1).

Diagram 1

Career paths inside the Iron Triangle of social security governance

After the 1996 reform, the members of the Cours des comptes were gradually replaced by young high civil servants from the General Inspectorate of Social Affairs (Inspection générale des affaires sociales, IGAS) and civil administrators (Administrateurs civils) (Table 4). Most of the latter began their careers as technical staff (in sectoral administrative sub-directorates) with the first generation of welfare elites. The proximity between the two generations with regard to career paths was accompanied by a commitment to the “sustainable social welfare” program. The constitutional reform of 1996 and the Douste-Blazy Law of 2004, transforming the governance of the funds with the creation of the National Union of Health Insurance Funds (Union nationale des caisses d’assurance maladie, UNCAM), expanded the number of executive positions available and opened up fresh career opportunities for young newcomers.

The comparative analysis of the career paths of the second generation, carried out on the database of our latest research (Research program III ProAcTA, see Table 1), has identified an unprecedented mode of circulation of welfare elites. They shape their careers by holding successive leadership positions in the Iron Triangle of social security governance (Diagram 1). This comprises three key institutions: the Directorate of Social Security (DSS),Footnote ²⁰ the National Union of Health Insurance Funds (UNCAM), and the group of sectoral high authorities and councils.Footnote ²¹ An important change with respect to the first generation is that the members of the second generation of welfare elites have extended their long careers within the high councils and authorities created to oversee policy implementation. This circulation of elites guarantees strong interconnections between the members of the two generations and continuity in the implementation of the “sustainable social welfare” program. This is why, since the end of the 2000s, social insurance advisors in ministerial offices are recruited mainly for their experience in governing policies acquired inside the Iron Triangle.

An in-depth analysis of the career paths of the two high civil servants who succeeded each other at the head of the DSS illustrates the effects of circulation within the Iron Triangle on the second generation of welfare elites.Footnote ²² The first, Dominique Libault, upon graduating from ENA joined the DSS as member of the corps of Administrateurs civils. He then moved directly to Simone Veil’s ministerial cabinet, between July 1993 and June 1995, as a technical advisor. Encouraged by Veil’s policy favoring internal career promotion, the young Libault re-entered the DSS and ascended through all the management positions (from 1995 to 2000): Deputy Director of Access to Health Care, Deputy Director in charge of the financing and management of Social Security, Deputy director, then Director under the Raffarin government. His appointment, under consideration during the socialist government of Jospin, was, for the time, highly symbolic because politically unexpected.Footnote ²³ Despite changes in government, he served as Director until 2012. Strongly protective of the autonomy acquired by the welfare elites in the implementation of the budget act, he worked in tandem with the management of the National Union of Health Insurance Funds (UNCAM) to achieve the annual National Health Spending Objective (ONDAM). As DSS director, he initiated a policy of recruiting young high civil servants, targeting statistical engineers in particular.Footnote ²⁴ This recruitment strategy was decisive in defeating the attempt to merge the finance laws, initiated by the Ministry of Finance, when the Ministry of Public Accounts was created in 2007. With a newly favorable balance of power in terms of staff, the welfare elites asserted their ability to control both the largest public budget and the development of public policies specific to social security. Upon leaving the Directorate of Social Security in 2012, Libault was appointed vice president and then president (2018) of the Higher Council for the Financing of Social Protection (HCFiPS).

The second career path is that of Thomas Fatôme (énarque, IGAS), Libault’s successor at the head of the DSS. Fatôme studied at HEC Business School before joining the IGAS after graduation from ENA (2000). He served as a health insurance policy advisor on multiple occasions in ministerial offices under the Chirac and Sarkozy presidencies, before being appointed as chief of staff of the director of the National Union of Health Insurance Funds (2005 to 2008). He then joined the DSS, first as deputy director under Dominique Libault (2009–2012) and then as director under the socialist presidency of François Hollande (2012–2017). Despite his appointment to several conservative ministerial cabinets and to President Nicolas Sarkozy’s team, he was retained as DSS director throughout Hollande’s socialist presidency. Under the Macron presidency, Fatôme was recruited as cabinet deputy director for Prime Minister Édouard Philippe in charge of social issues (2017–2020), then left this position on July 29, 2020 to become director general of the UNCAM. He thus became the first member of the welfare elite to have led two of the three pillars of the Iron Triangle of social security governance.

Several changes in social background and career path characterized the institutionalization of the second generation of welfare elites. The magistrates of the Cour des comptes were supplanted by high civil servants from less prestigious administrative corps. The recruitment strategy targeting statistical engineers helped to broaden the professional skills of the second generation. A study of their career paths reveals an increase in their length of service within the DSS, where the promotion of “deserving” young elites is marked by a vertical progression from office manager to deputy director, then to director.Footnote ²⁵ Beyond the DSS, the hallmark of career paths is horizontal circulation inside an Iron Triangle of governance of which the DSS is the cornerstone.Footnote ²⁶ In their own words, the second generation of welfare elites form a “small world” (“petit monde” as they put it), in which people reproduce and are interchangeable. This phenomenon explains the depoliticization of these insiders and their attachment to the role of custodian of state policies. This role is embodied in the commitment to “the reforms establishing the universality of social protection (General Social Insurance Contribution [CSG] and Universal Health Coverage [CMU]), […] strengthening the role of the state and in the search for financial sustainability through the execution of the Social Security Budget Act (LFSS).” ^{Footnote 27}

Furthermore, their institutionalization consubstantial with the transformation of the welfare regime favored the reconfiguration of the strong French state.

The Custodianship of “Sustainable Social Welfare”

Our Programmatic Elites Framework points out the effects of the institutionalization of the welfare elites on the development of the role of custodian of state policies in the field of social security and, more specifically, health insurance, which, as we saw above, presents the greatest challenges in terms of cost control. This role was established at the turn of the 2000s to defend the reforms implementing the “sustainable social welfare” program in the face of opponents, including social partners [unions], health professionals, and high civil servants from the Ministry of Finance. The program manifested itself in the adoption of national health coverage (1999, 2016, 2019), the establishment of state control of fund governance (2004) and the creation in 2007 of the Ministry of Public Accounts (see Tables 4 and 5). The assertion of the role of custodians has led to a reconfiguration of the French state around social security, whose policy domain has been expanded to include the management of emerging risks (such as dependency, the Covid-19 pandemic, climate change).

The other evidence of the emergence of the role of custodian was the implementation of national health coverage (CMU, 1999). Universal Health Coverage (CMU) decreed that every person residing lawfully in France, irrespective of their employment status or contribution record was insured for health risks [Hassenteufel and Palier Reference Hassenteufel and Palier2007: 591]. The CMU provided the poorest with free access to health care and free complementary health insurance for those who could not pay for complementary health care (CMU Complémentaire, CMU-C) [Palier Reference Palier2010: 84]. Finally, the Universal Health Protection Act (PUMa) came into effect on January 1, 2016 under the socialist presidency of François Hollande and the ministry of Marisol Touraine. It completes the universal right to health care coverage for “any person working or residing in France on a stable and regular basis” [Nay et al. Reference Nay, Béjan, Bénamouzig, Bergeron, Castel and Ventelou2016]. The CMU concerned only the “general health insurance scheme (régime général)” for salaried employees (and not the special schemes/régimes [for farmers, self-employed workers and non-salaried employees]). By opening up to all health insurance schemes/régimes, the PUMa facilitates access to and maintenance of rights in the event of a change in professional status (loss of employment) and/or family status (divorce), as well as for unemployed young people and women (elimination of the notion of major beneficiaries) [Tabuteau Reference Tabuteau2015 and Reference Tabuteau2016]. The PUMa enshrines the principle of a universal right attached to the individual, already contained in the CMU. The role of custodian of state policies was also developed around this programmatic axis that profoundly transformed the 1945 model.

The reform of social security governance, introduced with the Douste-Blazy law (2004), was another key step in the institutionalization of the welfare elites and their program. First, the National Union of Health Insurance Funds (UNCAM) was created, headed by a high civil servant and their office, to which the management authority of the social partners would now be subordinated [Hassenteufel and Palier Reference Hassenteufel and Palier2005; Hassenteufel Reference Hassenteufel2011]. This reform also led to the formation of the Iron Triangle, which favored the circulation of the second generation of the welfare elites at the top of health insurance governance. This new organization has facilitated collaboration between the DSS and the UNCAM for the implementation of the expenditure control policy. The National Health Spending Objectives (ONDAM, under 2% after 2005) and the Objectives and Management Agreements (COG)Footnote ²⁸ are negotiated and managed by the direction of the DSS and UNCAM. This new organizational context has reinforced the welfare elites. Their professional skills in health and social policy formulation and implementation sets them apart from their competitors [social partners, medical professionals, other lobbies). This has enabled them to design a range of policy instruments to make expenditure control effective, especially in the important sector of public medicine. The “Hospital Plan 2007” introduced the prospective payment system (Tarification des actes médicaux en milieu hospitalier, T2A) in hospitals (with the Social Security Budget Act n° 2003- 1199 of December 18, 2003).Footnote ²⁹

One year before the global financial crisis (2008) and its inexorably deepening public deficits, Nicolas Sarkozy at the beginning of his presidency created a Ministry of Public Accounts (Decree n°2007-1003 of May 31, 2007) and placed the DSS under the “dual supervision” of the Ministry of Health and Social Affairs and the Ministry of Economy and Finance. In this context, the elites of the Directorate of the Budget (Ministry of Finance) planned to merge the Social Security Budget Act [an exception in Europe) with the State Budget Act. This political strategy would have had the effect of ending the budgetary autonomy acquired by the welfare elites. To counteract it, the latter, assuming their role of custodians of state policies, demonstrated their unique expertise to combine expenditure control and the formulation of specific policies linked to health insurance issues [including health care and health coverage), and, against all expectations, enhanced their governing capacity. Indeed, their career paths within the Iron Triangle had reinforced this twofold policy competence illustrated each year during implementation of the ONDAM. Thanks to this expertise, during settlements (arbitration) within the Ministry of Public Accounts, the welfare elites imposed their vision of health insurance policy on the elites of the Directorate of the Budget.

The quest for efficiency meant that the welfare elites had to avoid a loss of control over public healthcare spending. Just after the financial crisis, in 2010, the social security deficit was €29.6 billion; by 2015 it had fallen to €10.2 billion,Footnote ³⁰ and by 2018 to €1.4 billion, before rebounding to €1.7 billion in 2019. As a result of the Covid-19 pandemic in 2020, however, it surged back up to €39.7 billion,Footnote ³¹ although it was expected to fall back down to €21.6 billion in 2022.Footnote ³² Faced with these critical junctures, the challenge was to consolidate their program. In response to the Covid-19 pandemic, they quickly drafted the health and health insurance parts of the state of emergency voted by Parliament on March 24, 2020.

In 2019, the crisis triggered by the Covid-19 pandemic has not challenged implementation of the “sustainable social welfare” program. The political elites, the medical elites, and the welfare elites were caught off guard for a while during the initial pandemic months. But, at first reactively, then proactively, the government’s implementation of a “state of emergency,” the Ségur de la Santé (the general consultation of health care actors in 2020)Footnote ³³ and the vaccine policy led to the progressive curbing of the pandemic. In this unprecedented crisis, the welfare elites once again drew upon their skills to control social security spending, which was under pressure. It is important to emphasize that their action was not limited to rebalancing the budget deficit in the health insurance accounts. They also expanded their program of “sustainable social welfare” by creating, in 2020, a fifth branch (Cinquième branche) dedicated to care provision for dependency arising from old age and disability. This direction given to the development of social security is, in our view, the hallmark of the reconfiguration of the strong French state.

Elites, Custodianship and the Reconfiguration of the French Strong State

This article has traced the work of French welfare elites who, in a difficult economic and social context beginning in the mid-1970s, worked “out of sight” to design and implement a “sustainable social welfare” program. By gaining power in the upper echelons of the central state, they not only launched a policy of cost containment, but also reformed its governance by enlarging the role of the state. In fact, during the Trente glorieuses, the administrative elites, made up of magistrates of the Conseil d’État, had little power in the governance of social security, which was essentially in the hands of the unions. This situation changed in the 1980s with the emergence of welfare elites. A first generation of the latter, made up of magistrates from the Cour de comptes promoted a new programmatic orientation strengthening the state’s authority over the welfare regime. A second generation reinforced their institutionalization in social security governance. The Directorate of Social Security was transformed into a cornerstone of the Iron Triangle of social security governance, composed of three pillars: (i) the DSS, (ii) the directorate of the National Union of Health Insurance funds (UNCAM), and (iii) the high authorities (Hautes autorités) in the health and social policy domain. The career path of this second generation was shaped as they circulated vertically and horizontally within this Iron Triangle, in which they built a common identity and honed their role as custodians of state policies by implementing their program. The latter took shape after many battles, first with the “old-fashioned” elites of social security and then with the elites of the Ministry of Finance.

In addition to its contribution to understanding the transformation of France’s welfare regime, this article points toward more general conclusions for the sociology of elites and study of the reconfiguration of democratic states. With the programmatic elites framework, we have established a connection between the transformation of elite structure (social backgrounds and career paths) within the state apparatus and the programmatic orientations they bring to decision-making. Unelected governmental elites are thus described in terms of their proactive role as custodians of state policies [Genieys Reference Genieys2010, Reference Genieys2024]. Like the “carriers” (träger) of values and actions promoting the processes of state- and nation-building described by Juan Linz [Reference Linz1993], we have identified elite groups promoting state interventionism in the context of transformation of the welfare regime. This role is reflected in programmatic guidelines that reinforce the state’s capacity to intervene. For us, the elites acting as custodians are close to what Bergeron and Castel call “entrepreneurs of change” [Bergeron and Castel Reference Bergeron and Castel2015]. Their custodial attitude is guided by a value system that, from their point of view, must be “responsible.” Their actions are characterized by (i) the ethics of ultimate ends promoting the extension of state interventionism, and (ii) the ethics of responsibility shaping “sustainable” policies.

This perspective sheds new light on the so-called dismantling of democratic states [Suleiman Reference Suleiman2003]. Studies on the transformation of bureaucratic power have generally associated the development of New Public Management with the retreat of the state. New Public Management, by promoting the deprofessionalization and politicization of unelected governmental elites, is said to have affected the state’s ability to produce and implement public policies in the United States and Europe [Suleiman Reference Suleiman2003: 17]. Recent research on administrative modernization in France contradicts this interpretation, however, pointing out how senior civil servants turned this change to their advantage [Gibert and Thoenig Reference Gibert and Thoenig2022: 191–194]. Our comparison of the French and US cases shows that unelected governmental elites may develop specialized long-term career paths in certain areas of public policy.

In the configuration of the strong French state [Birnbaum Reference Birnbaum2001, Reference Birnbaum2018]—for example, centralized with a large bureaucracy and endowed with a “state culture” [Nettl Reference Nettl1968]—it is groups of elites with high civil servant status who have developed the role of “custodian of state policies.” In the US policy state, these unelected governmental elites have different statuses and career paths (mainly political appointees and members of Congressional committees hired on private contracts). The development of the custodian role has adapted to the weakness of the federal government, which remains more sectoralized and reluctant to allow senior officials to govern policy [Genieys Reference Genieys2024]. Moreover, unlike the French case, the development of this role in the United States remains more dependent on partisan polarization (Republicans versus Democrats). Orren and Skowronek [Reference Orren and Skowronek2017] have shown that, during the twentieth century, the policy state’s capacity to intervene was strengthened during periods of Democratic political hegemony (“progressive era,” “Great Society”). The predominance of the Republican Party from the 1980s onwards initiated retrenchment policies seeking to reduce the perimeter of state intervention [Orren and Skowronek Reference Orren and Skowronek2017; Pierson Reference Pierson1994], although this did not prevent the role of the state strengthening in relation to defense policy [Glenn and Teles Reference Glenn and Teles2009; Jacobs, King and Milkis Reference Jacobs, King and Milkis2019]. However, this conservative counter-attack did not prevent the emergence of custodian elites around reform of the Affordable Care Act [Genieys Reference Genieys2024].

On the other hand, in both cases, certain groups of unelected governmental elites have asserted their custodianship around programmatic orientations considered financially sustainable. They face the challenge of managing a constantly growing public budget. While in the United States, federal public spending on health insurance remains lower than on defense, in France, the social security budget (which goes far beyond health insurance) has overtaken that of the state. In the case of the weak US state, the Trump administration’s tax cuts temporarily curbed development of the Affordable Care Act. In France, despite globalization, new Europe-wide powers, and the so-called ascendancy of neoliberal ideology, “custodial” elites have been able to reassert the authority of the strong state. This reassertion has entailed new modes of intervention. The craftsmen of these reconfigurative modes are the welfare elites, who have placed social security and its policies at the heart of a redefinition of state authority and the public interest.